Enhancing Housing First Programs With a Social Network Substance Use Intervention

We propose a 3-year study to develop and pilot test a social network substance use and
HIV-risk intervention for permanent supportive housing program residents in the Skid Row area
of Los Angeles. The intervention will be developed for residents at the Skid Row Housing
Trust (SRHT), one of the largest Housing First providers in Los Angeles. Housing First
residents are not required to abstain from alcohol and drugs as a requirement of their
residency. There is some evidence that providing housing rapidly to chronically homeless
persons--along with support--helps to reduce substance use and HIV risk behaviors in the
short term because homelessness is the primary cause of high-risk behavior. However, the
evidence thus far is limited. One aspect that has not received much research attention is the
needs of Housing First residents for support to transition their social networks while
transitioning out of homeless into residency in a Housing First program. New residents are
exposed to a wide range of potentially negative social influences while also having greater
potential to reconnect with lost positive ties. This project will develop a social network
intervention to residents of SRHT in order to increase their knowledge about their social
networks and enhance their motivation to make necessary changes to improve their ability to
reduce or continue to abstain from high-risk behavior. The intervention sessions will enhance
the weekly support meetings that SRHT case workers already conduct with new residents during
their first 6 months of residency. Case workers will be trained to deliver the 30-minute
intervention sessions using a motivational interviewing style. The intervention will be
developed so that case managers can deliver it with the aid of an electronic tablet device.
The tablet will guide them in collecting information about the residents' social networks and
then display several diagrams highlighting various aspects of the residents' networks. They
will then use motivational interviewing techniques to guide residents to think about how
their network currently functions, how they would like it to function, and what steps they
can take to make changes necessary to achieve goals related to reducing their substance use
and sexual risk behaviors. The intervention will be delivered by case managers across four
sessions (at baseline and at two-week intervals). We anticipate that residents who
participate in this intervention will develop new strategies in their interactions with their
social networks that will facilitate a reduction in their high-risk behavior.

Inclusion Criteria:

- New residents of Skid Row Housing Trust receiving permanent supportive housing

Exclusion Criteria:

- Age younger than 18

- Does not speak English

- Cognitively impaired either by identifying those having a diagnosis of dementia in the
new resident intake interview or using the Short Blessed Scale Exam)

- Does not screen positive for past -year harmful AOD use using the AUDIT-C (a score > 4
for men and > 3 for women) and DAST (a score greater than 2).